The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study.

The aim of this study was to evaluate the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a population of older adults living in nursing homes. Furthermore, we also intended to assess the possible association between polypharmacy, potentially inappropriate medications and cognitive impairment in institutionalized older adults. A cross-sectional study analyzed data from 193 nursing home residents in the district of Viseu, Portugal, between September 2018 and June 2019, with a mean age of 82.4 ± 6.2 years (ranging from 65 to 95 years old); 72.5% (n = 140) were female participants. Major polypharmacy was presented in 80.8% of the study population, who took 7.6 ± 3.3 drugs per day. Using the Beers Criteria, we found that 79.3% took PIMs. There was a positive association between polypharmacy and PIM (p < 0.001), showing that higher medicines intake increased the number of PIMs. Polypharmacy was not associated with the functionality of the older adults to perform activities of daily living, but was associated with cognitive impairment. The older adults with lower scores on the Mini Mental State Examination (MMSE) took more drugs (p = 0.039) and used more PIM (p < 0.001). Moreover, patients taking five or more prescription drugs per day (major polypharmacy) consuming any psychiatric, gastrointestinal or oral antidiabetic agents (regardless of whether they were considered potentially inappropriate or not) had higher odds of displaying cognitive impairment than those who did not (p < 0.05). Older adult residents of the studied nursing homes were potentially affected by polypharmacy and inappropriate polypharmacy. This observation reveals the need to adopt and implement strategies that make drug therapy more adequate and safer for older adults.

The Role of Nutritional Status on Polypharmacy, Cognition, and Functional Capacity of Institutionalized Elderly: A Systematic Review.

Adequate nutritional status is necessary for the proper management of polypharmacy, the prevention of cognitive decline, and the maintenance of functional capacity in activities of daily living. Although several studies validate this fact for the general elderly population, data on institutionalized seniors concerning this relation are scarce. A systematic review was performed according to the PRISMA guidelines, aiming to study the potential correlation between nutritional status and polypharmacy, cognitive decline, and functional performance in institutionalized elders. The search was limited to studies in English or Portuguese in the last decade. Inclusion criteria relied on the PICO method. Five studies explored the relationship of nutritional status with cognitive performance in the institutionalized elderly, and nine prospective observational studies reported significant positive associations between appropriate nutritional status and physical abilities. Nutritional status was primarily measured by MNA. Adequate nutritional status was described as an important parameter in preventing cognitive and functional decline in the institutionalized elderly. No studies were found describing the impact of nutritional status on the prevention of polypharmacy. Given the strong impact of malnutrition found in the studies in cognition and functional abilities in the institutionalized elderly, an evaluation of nutritional status of the elders is crucial to prevent health problems and allow early intervention programs in order to further prevent health decline.

The Relationship between Nutritional Status and Functional Capacity: A Contribution Study in Institutionalised Portuguese Older Adults.

Demographic aging of the population allied with the new family structures and societal dynamics is generating an increasing demand for institutions for older adults. Nutritional status is a key health determinant that impacts the quality of life among older adults. Hence, the aim of the present study was to evaluate the relationship between nutritional status and nutritional risk, functional capacity, and cognition in institutionalised Portuguese older adults by a cross-sectional study in 15 institutions. Nutritional status (body mass index (BMI), waist circumference (WC), nutritional risk (mini nutritional assessment (MNA)), degree of functional independence (Barthel index (BI)), and cognitive ability (mini mental state examination (MMSE)) were assessed. Of the 214 older adults evaluated, 28.0% were at risk of malnutrition, 69.6% were mildly functional dependent, and 39.3% presented minor cognitive impairment. The risk of malnutrition increased functional dependence and cognitive impairment. The MNA score, but not the BMI or WC, was related to disability and deficits in cognition. A differential interdependence was found between nutritional, cognitive, and functional status. Strategies to improve self-care and well-being in nursing homes should consider a correct diet and a closer evaluation of nutritional risk to preserve cognition, independence, and autonomy.